The Role of Intraoperative Microvascular Doppler Sonography in Cerebral Aneurysm Surgery

Background: The goal of our study was determination of the role of the intraoperative microvascular doppler sonography (MDS) in cerebral hemodynamics in aneurysm surgery.

Methods: Twenty five patients (14 female and 11 male) with mean age of 57 years, admitted for surgery of cerebral aneurysms were involved in this study within 15 months. Intraoperative 20 mhz microvascular doppler sonography of aneurysm sac and surrounding vessels was performed intraoperatively, before, and after aneurysm clipping to confirm complete obliteration of the aneurysm sac and patency of surrounding vessles. After operation, arterial CT angiography was performed in 91% of patients and the data from intraoperative microvascular doppler sonography was analyzed and compared with postoperative arterial CT angiograms.

Findings: Microvascular doppler sonography with 1 mm diameter probe was able to insonate all surrounding vessles including perforating arteries and aneurysm sacs. Aneurysm clips were replaced 5 times during operations (21% of cases); 2 cases due to obstraction of surrounding vessles, 2 cases because of incomplete obliteration of aneurysm sac, and in one case because of both, obstraction of surrounding vessles and incomplete obliteration of the aneurysm. Mean time for operation of sonography was 7 minutas. Findings of postoperative CT angiography were consistent with those of intraoperative microvascular doppler sonography in all cases.

Conclusion: Due to simplicity, safetiness, and not being time-consuming, and also because of giving invaluable information about patency of the surrounding vessles and complete clipping of aneurysm sacs, intraoperative microvascular doppler sonography is recommended in cerebral aneurysm surgery.

Key words: Microvascular doppler sonogrphy, Cerebral aneurysm.